Healthcare Provider Details

I. General information

NPI: 1043999642
Provider Name (Legal Business Name): FOOT AND WOUND INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 DOXBURY LN
NEW LENOX IL
60451-3454
US

IV. Provider business mailing address

475 DOXBURY LN
NEW LENOX IL
60451-3454
US

V. Phone/Fax

Practice location:
  • Phone: 708-271-3537
  • Fax:
Mailing address:
  • Phone: 708-271-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADANNA C OKOLIE
Title or Position: DIRECTOR
Credential: NPC
Phone: 708-271-3537